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collection system. OIRA staff members administer the statewide programs and are
responsible for program development, coordination, monitoring, reporting, training,
technical assistance, and administration.
Eligibility for the Refugee Medical Assistance (RMA) program is overseen by the
Centralized Benefits Services (CBS) unit, under the direction of Wayne Salter, Associate
Commissioner, Eligibility Services within the OSS. CBS facilitates telephone interviews
for the application and review process of RMA and associated Supplemental Nutrition
Assistance Program (SNAP) and Temporary Aid for Needy Families (TANF) cases.
RMA remains the primary medical coverage for newly arriving adult single individuals
and married couples without children.
HHSC contracts with the Department of State Health Services (DSHS) to provide
Refugee Health Screening services and contracts with the Department of Family and
Protective Services (DFPS) to administer the Unaccompanied Refugee Minor (URM)
program.
Texas does not have a General Assistance program; RCA and TANF are the only cash
assistance programs. The RCA program in Texas follows a public/private partnership
model. Refugee resettlement agencies are responsible for determining client eligibility
and dispensing cash benefits.
C. Assurances
1. OIRA assures ORR that it will comply with all provisions of Title IV, Chapter 2 of the
Act, and official issuances of the Director (400.5(i)(1)
2. OIRA assures ORR that it will meet the requirements specified in Title 45 of the Code of
Federal Regulations (CFR), Part 400.5(i)(2).
3. OIRA will comply with all other applicable federal statutes and regulations in effect
during the time that it is receiving grant funding as specified in 400.5(i)(3).
4. OIRA will amend the Plan to comply with ORR standards, goals and priorities
established by the Director as needed as specified in 400.5(i)(4).
5. OIRA assures ORR that assistance and services funded under the plan will be provided to
refugees without regard to race, religion, nationality, sex or political opinion as required
by 400.5(g).
6. In accordance with 400.5(h), OIRA, unless exempted, assures that meetings are
convened, not less often than quarterly, whereby representatives of local resettlement
agencies, local community services agencies, and other agencies that serve refugees meet
with representatives of state and local governments to plan and coordinate the appropriate
placement of refugees in advance of the refugees' arrival.
7. OIRA does not have a publicly administered RCA program, and therefore, it will not use
the same mediation/conciliation procedures as those for TANF.
8. OIRA will use the hearing standards and procedures as set forth in 400.83(b) for the
RCA program.
9. OIRA provides assurance that refugee programs and populations are included in the State
pandemic influenza emergency plan and other emergency operational plans.
Section II Assistance and Services
A. In accordance with 400.5(b), OIRA will coordinate cash and medical assistance with
support services under the RCA program as follows.
OIRA is responsible for statewide contracts with existing local resettlement agencies for
the administration of RCA funds. OIRA, in conjunction with local resettlement agencies
and other refugee stakeholders, is responsible for the implementation and maintenance of
the RCA program.
Resettlement agencies providing employment services are required to provide referral
services and follow up to other appropriate refugee social services. RCA participants
continue to be priority one clients in all refugee social services.
OIRA and local resettlement agencies must maintain ongoing coordination with other
refugee organizations to ensure that the services provided under the RCA program are 1)
appropriate to the linguistic and cultural needs of the incoming populations; and 2)
coordinated with state refugee social services and longer-term resettlement services
frequently provided by other refugee organizations.
HHSC procures RCA services through open enrollment contracts. Under the open
enrollment process, any resettlement agency in the State of Texas is eligible to provide
RCA services provided they meet minimum standards for state contracting. Each
individual resettlement agency is responsible for determining program eligibility and
providing cash assistance according to the RCA program.
Under the approved RCA program, all applicants for RCA must be categorically
ineligible for TANF. In Texas, single individuals without children are not eligible for
TANF. Families with children must submit an application for TANF to CBS to
determine eligibility based on income and family composition. TANF is generally
applied for simultaneously with SNAP, Medicaid, and CHIP.
B. As required by 400.5(c), OIRA assures ORR of the availability of language training and
employment services for refugees receiving cash assistance and other refugee
populations, including efforts to encourage the use of employment services.
Refugees receiving RCA are a primary priority for refugee funded employability
services. In order to ensure that employment services and language training are linked to
RCA recipients, OIRA dedicates a percentage of the total available Refugee Social
Service funding for the provision of employment services to RCA clients through
enrollment contracts. These services are administered by the same resettlement agencies
that also administer the RCA program. This ensures that contractors administering the
RCA program will also receive dedicated employment funds for RCA recipients. This
ensures that RCA participants residing in areas of the state where there are resettlement
agencies have access to employment services to be in compliance with Code of Federal
Regulations Part 400.75 which mandates registration for employment services and
acceptance of appropriate employment.
Remaining social service funds are awarded competitively to refugee resettlement
agencies and other faith-and community-based organizations in areas of the state that
resettle 100 or more refugees annually. These competitively procured services are
provided in Taylor, Potter, Travis, Dallas, Tarrant, Harris, and Bexar counties and
adjacent areas.
Contractors are also required to refer and help all eligible refugees to access other
employability services in their community including Education, Social Adjustment and
Integration Services. All contractors are required to conduct outreach activities in the
community, which includes notifying all local refugee resettlement offices of the
availability of language and employment services.
OIRA also requires contractors to network with other agencies in the community,
including language instruction and literacy groups, to make their services known and to
develop additional resources for refugee services.
C. Refugee Cash Assistance (RCA) 45 CFR Part 400.45
1. RCA program elements
a) RCA contractors verify applicants income at the time of application for
months 1 through 4 and at the time of recertification for months 5 through 8.
The income eligibility standard for enrollment in RCA benefits during months
1 through 4 is 125% of the Federal Poverty Income Limit (FPIL). The income
eligibility standard for enrollment during months 5 through 8 is 165% of the
FPIL. All refugees found eligible at the date of application and who are in
compliance with participation requirements will receive cash/vendor
assistance through month 4 regardless of income. For months 5 through 8,
benefits will continue if the refugee is under 165% of the FPIL regardless of
income.
b) TANF and RCA payment levels
Non-Caretaker Cases
Family
Size
Bud
Needs
(100%)
Rec
Needs
(25%)
Max
Grant
Bud
Needs
(100%)
Rec
Needs
(25%)
Max
Grant
Bud
Needs
(100%)
Rec
Needs
(25%)
Max
Grant
1
2
3
4
5
256
369
518
617
793
64
92
130
154
198
96
138
194
231
297
313
650
751
903
1003
78*
163
188
226
251
117
243
281
338
375
--498
824
925
1073
--125**
206
231
268
--186
308
346
401
$1,534
-1,534
$0
c) The Texas RCA program does not consider proration of shelter, utilities and
similar needs under 400.66(a)(3).
d) All financial eligibility and payment rules are outlined in this section.
e) In accordance with 400.66(b), OIRA assures ORR that the Texas RCA
program will not consider resources remaining in the applicants country of
origin.
f) In accordance with 400.66(c), OIRA assures ORR that the Texas RCA
program will not consider a sponsors income and resources as accessible to
the refugee solely because the person is serving as a sponsor.
g) In accordance with 400.66(d), OIRA assures ORR that the Texas RCA
program will not consider any cash grant received by the applicant under the
Department of State or Department of Justice Reception and Placement
programs.
h) OIRA uses the date of application as the date RCA begins
i) The State does not administer RCA and therefore notification to the local
resettlement agency is not required.
j) The State does not administer RCA and therefore notification to the
applicants sponsor regarding offers of employment is not required.
k) The Texas RCA program is within prescribed assistance and budget levels as
defined in 400.60
l) A RCA recipient who is employed within the first three months and has been
employed at least 35 hours per week for at least 30 days is eligible to receive
an early employment incentive payment. Note: To ensure encouragement of
early employment, refugees who do attain early employment, also receive
payments through month four. Incentive payment levels are defined in the
tables above.
m) The Texas RCA program includes the following exemptions from
participating in employability services. Since economic self-sufficiency is the
ultimate goal of the refugee program, circumstances that allow for an
employability exemption are limited, and provided for by agency rule, which
includes:
Age 15 or younger
Age 16, 17 or 18 and attending elementary, secondary, vocational,
or technical school full time
Age 60 or older
Permanently disabled. Permanently disabled means a mental or
physical impairment that is expected last more than 90 days.
Needed at home to care for an ill or disabled child/adult in the
household. The caretaker must provide a current doctor's
statement to claim this exemption unless the child/adult receives a
permanent government disability benefit.
Unable to work as a result of pregnancy
A single parent or single caretaker relative for a child under age
one at initial application. (Note: neither parent in a two-parent
household may receive a caretaker exemption.)
2.
All refugees are given the opportunity to apply for medical assistance including
Medicaid, CHIP, or RMA. Eligibility is determined by a centralized eligibility
office responsible for all initial refugee applications in the state.
a) Eligibility caseworkers use the Texas Integrated Eligibility System (TIERS)
which cascades through all possible Medicaid programs to check eligibility
prior to enrolling refugee clients into RMA. Recertification for ongoing
medical benefits is processed through local state eligibility offices. This can
be done in person or online.
b) Newly arriving refugees who may be eligible for Medicaid or RMA, SNAP,
TANF or CHIP are assisted in preparing the HHSC Application for Assistance
and submitting the application to HHSC's Centralized Benefit Services (CBS).
Resettlement agency staff is designated as authorized representatives for
clients and assist with the phone interview and necessary follow up. CBS
utilizes eight state office staff to determine eligibility for RMA benefits and
associated SNAP and TANF cases.
RMA will remain the primary medical coverage for many newly arriving adult
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refugees given that Texas did not opt to expand Medicaid under the Affordable Care
Act.
2. RMA eligibility is based on applicant's income and resources on the date of
application. Income and resource increases do not affect eligibility, unless the
individual subsequently applies and qualifies for another type of Medicaid.
a) The Texas RMA standard is set at 200% of the Federal Poverty
Income Limit. Texas uses modified adjusted gross income (MAGI)
methodologies to determine RMA eligibility. Resources are
applicable when determining eligibility for RMA.
b) In accordance with 400.102, caseworkers do not consider any Match
Grant or Reception & Placement (R&P) cash assistance payments, or
in-kind services and shelter provided to an applicant by a sponsor or
local resettlement agency in determining eligibility for RMA.
In determining RMA eligibility, the refugee must be determined ineligible for
Medicaid and the Childrens Health Insurance Program (CHIP).
If determined ineligible for Medicaid or CHIP, eligibility will be determined for
RMA. In the event that an individual is ineligible for RMA due to income, they will
be referred to the Marketplace.
3. OIRA provides assurance of compliance with continued coverage of
recipients per requirements under 400.104 and 400.105
4. RMA services are currently fee- for- service and cover the same services as
Medicaid.
5. Additional services (400.106)
a) In addition to the components of the ORR Medical Screening
Guidelines, the Texas Department of State Health Services (DSHS)
Refugee Health Program (RHP) provides ova and parasite (O&P)
screening for protozoa (at select clinics), provides treatment for
identified parasites, and treats limited minor conditions not needing
referrals (such as cuts, lice, etc.). These activities ensure that clients
can be treated for minor conditions immediately instead of referring
clients to a primary care physician, which may take several weeks,
and/or utilizing urgent care facilities. Screening and treating for
intestinal parasites by providers familiar with the practice is essential
for providing appropriate care for this patient population.
6. Program-eligible clients served by a refugee resettlement agency are referred
to a local health department (LHD), Refugee Health Program clinic for a
health assessment. The Refugee Health Program (RHP) works with
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12
The DSHS RHP also contracts with the City of Midland Health
Department to provide vaccination services.
d) Local health department-based refugee health programs bill Medicaid
when a billing infrastructure exists. Traditional public health entities
do not bill insurance for payment and many lack the infrastructure to
do so. Two LHDs have recently began to attempt to bill the majority
of screening components to Medicaid, including office visits, vaccines
and vaccine administration, and laboratory tests. One LHD is billing
for laboratory tests and is beginning to explore other billing
possibilities. . The other three LHDs do not currently bill any services
to Medicaid, but are exploring required steps to be able to do so in the
future.
At the state level, the Texas DSHS RHP accesses Medicaid where
possible and practical. The DSHS state laboratory services section
runs RHP submissions against a Medicaid list. The state program
continues to work with the state laboratory and local RHPs to ensure
Medicaid eligibility documentation on laboratory specimen submission
slips.
It should be noted that Medicaid in the state of Texas serves primarily
low income families, children, related caretakers of dependent
children, pregnant women, elderly, and people with disabilities. In
general, state Medicaid policy does not include any coverage for
childless individuals ages 18 to 44. Therefore, this segment of the
refugee population in Texas does not meet the eligibility criteria for
Medicaid. Medicaid expansion under the Affordable Care Act has not
taken place in Texas. RMA provides the needed assistance during the
first eight months of arrival and ensures necessary screening for public
health concerns and the well-being of clients as they transition into
residents of the United States.
7. Refugee Medical Assistance Costs
a) RMA direct costs are fee for service and include non-medical costs
such as interpretation and transportation on an as needed basis to the
same extent as Medicaid.
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14
program clinics are not initiating care beyond the 90 day mark. 100% of clients
screened in the first tri-annual period of fiscal year 2015 were seen within 90
days.
3. Medical Screening Costs
a) The medical screening payment model is based on negotiated contract budgets.
Services included in direct costs that are non-medical include interpretation,
transportation, travel, move costs, and postage and printing.
Medical Screening Direct Costs
The majority of funds will support contractual services at the seven local health
departments (LHDs), as well as state laboratory services and medications. A
breakdown of costs is as follows: $4,198,042 for personnel, $1,838,076 for fringe,
$38,665 for in-state and local travel, $1,003,431 for equipment (move costs and
furnishings), $4,008,196 for supplies (medical supplies, office supplies, and
vaccines), $2,715,659 for contractual services (lab services, physician time,
interpreting costs), $963,104 for other costs (postage, printing, transportation),
and $725,140 in indirect costs. Much of the increase in the proposed budget is due
to increased needs for clinic space and staffing levels required to provide quality
patient care.
A breakdown of estimated RMA direct costs of health assessments in federal
fiscal year 2015-2016 also includes $250,000 for state laboratory costs for refugee
health assessment activities and $6,125,000 for medications. Laboratory costs are
for Ova and Parasite (O&P) and schistosomiasis testing. Medication costs are for
limited treatments provided to program-eligible clients (mainly vitamins and antiparasitics). In fiscal year 2016, the two largest local RHPs will begin
presumptively treating for parasites. These clinics, located within the Dallas
County Department of Health and Human Services and Harris County Public
Health and Environmental Services account for 60% of the client population in
the state. Despite an increase in overseas presumptive treatment, domestic
medication costs remain high due to the fact that the anti-helminth albendazole
has increased from $2.00 per tablet (in 2008) to the current price of $102.00 per
tablet.
Funding is also used for services in two secondary migration sites where there is
no local refugee health clinic. These sites are the City of Midland Health
Department (a contracted local health department) and DSHS Health Services
Region 1 serving Cactus and Dumas, Texas. In order to apply for Legal
Permanent Residency, refugees are required to obtain a current set of
vaccinations. Vaccines are provided by local public health departments to
refugees for Adjustment of Status purposes (within one year of arrival). The
combined funding for this purpose is $39,646 for adult vaccines.
Total Direct Costs: $21,875,313
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2. All social services are consistent with 400.154/400.155. Contractors are also required
to refer and help all eligible refugees to access other employability services in their
community and to conduct outreach activities in the community.
a) Citizenship and naturalization preparation services and assistance with obtaining
Employment Authorization Documents do not include the application fee to the
United States Citizenship and Immigration Services (USCIS).
G.
H.
entitled. This is in compliance with CFR 44, Section 400 Subpart HChild Welfare Services.
4. On site DFPS contract monitoring reviews are conducted annually or
more frequently, if deemed necessary. These monitoring reviews
include a team consisting of the DFPS Contract Manager, the DFPS
URM Program Specialist, the Contract Manager for the HHSC/DFPS
contract, and the OIRA Program Specialist. The Texas URM
Programs are also monitored annually by Residential Child Care
Licensing (RCCL), a division of the Texas Department of Family and
Protective Services. In addition, the state child welfare agency
monitors activity of the URM provider through various other means
including:
Monthly and trimester reports
Monthly scan calls with both programs
Quarterly visits to the program providing Technical
Assistance as needed
Contractual reporting requirements
Annual contract/program monitoring
Monthly meetings with URM Program Provider officials and
OIRA.
b) OIRA assures ORR the following:
1.
2.
3.
1.
2.
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The private agencies file an annual review for each URM case
with the court.
4.
4.
19
A youth must
be
18 - 21 years of
age
and...
regularly attending high school or
enrolled in a program leading to a high
school diploma or a high school
equivalency certificate (GED).
18 - 20 years of
age
he or she completes or
withdraws from the program or
the end of the month in which
the youth turns 21 years old,
whichever comes first.
Youth no longer engaged
required activities will have a
maximum of 30 days in which
to begin participation in another
educational or work related
activity in order to remain
continuously eligible for
extended foster care.
he or she withdraws from the
program or the end of the month
in which the youth turns 21
years old (annual documentation
required).
d) The chart above outlines independent living services or education benefits and
the higher age that eligibility for such services and benefits end.
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5.
Reunification;
Adoption by a relative or other suitable individual;
Permanent managing conservatorship to a relative or other suitable
individual; or
Another planned permanent living arrangement for the child.
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c) The State assures that the following elements are addressed in case plans and
reviewed during DFPS monitoring visits:
Family Reunification
Placement
Health Screening and Treatment
Mental Health Needs
Social Adjustment
Education/Training
English Language Training
Career Planning
Preparation for Thdependent Living
Preservation of Ethnic and Religious Heritage
a) The Texas URM Programs follow the Interstate Compact for the Placement of
Children (ICPC) in parity with DFPS.
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